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A,.-PLICATION - LOT LINL ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed'Squar <br /> Parcel Number xistin or Proed Use of Parcel Footage or Acreage oota a or Acres e <br /> / rye s ` �- <br /> r es 22 4 <br /> t <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Pubiic <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing <br /> i Private Watertf I ExistingWell New Well Well Replacement ❑ <br /> Sewage Disposal <br /> i Public Sewage Annex-Formation Distance to Public <br /> Disposal. Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Existing -��- <br /> 1 On-site Sewa e <br /> Dis osal stip Se tic S em New Se tic S tem Other ❑ <br /> oral Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terming!Drainage Detention-Retention <br /> r to: Ponds <br /> Proposed❑ <br /> R aired <br /> Existing❑ <br /> Private Storm <br /> Drainage On-site Retention Ponds Natural Drains e1No Chane r td Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> - G. -S't <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School 5ervi Provides Distance to Fire Station <br /> e s r e- <br /> Existina Roads <br /> Road/StreetName R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> U Z Yes❑ No Yes❑ N <br /> 1 Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> e.Yes '"Ne 0 Yes❑ No❑ <br /> k <br /> F:0EV5vclP1arvdn9 Appikadan Forms► Page 4 of 7 - <br /> W Line Adjusuneadw.(Revised 64-04) <br /> f' <br /> I <br />